top of page

Tel: 1-760-338-8213

inkscape_logo_white

Clínica de acupuntura y hierbas de Cai

Nuestra clínica le da la bienvenida en la enfermedad y en la salud.

Casa
New Page
New Page
New Page
Servicios
New Page
Libro en línea
Acerca de
Preguntas más frecuentes
Tienda
Blog
Miembros
Plans & Pricing
More

Use tab to navigate through the menu items.

Cai's Clinic of Acupuncture and Herbs Consent Form

If you agree with both Pages on the right, Please fill out the below form.

First Name

Last Name

Health Care Provider-Patient Arbitration Agreement. Choosing "YES" means that you Agree and Sign Aritcle 1, Article 2, Article 3, Article 4, Article 5, Article 6 from the form on the right side of this page. *

No

Yes

Division of Clinics Informed Consent to Acupuncture/ Oriental Medicine Treatment. Choosing "YES" means that you Agree and Sign with the form on the right side of this page (second form). *

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Contacto

Tel: 1-760-338-8213

Seguir

© 2018 por la Clínica de Acupuntura y Hierbas de Cai. Orgullosamente creado con Wix.com

bottom of page